J Clin Neurol.  2007 Dec;3(4):200-203. 10.3988/jcn.2007.3.4.200.

Progressive Multifocal Leukoencephalopathy in AIDS: Proton MR Spectroscopy Patterns of Asynchronous Lesions Confirmed by Serial Diffusion-Weighted Imaging and Apparent Diffusion Coefficient Mapping

• Yoon JH
• Bang OY
• Kim HS

• KMID: 1808557
• DOI: http://doi.org/10.3988/jcn.2007.3.4.200

Abstract

Progressive multifocal leukoencephalopathy (PML) is a rare disease that occurs mainly in immunocompromised patients. Despite the progressive nature of the disease, the changes on MRI during the disease course - which may help in monitoring the disease process - have seldom been reported. Here we describe a patient with polymerase-chain-reaction-proven PML examined using serial diffusion-weighted imaging (DWI) and apparent-diffusion-coefficient mapping. Magnetic resonance spectroscopy (MRS) revealed that the demyelinating process was more active without significant neuronal loss at the newer and advancing edge of a lesion than in the older central part of the lesion. This case shows that MRI findings such as DWI and MRS may improve the diagnosis and the understanding of the pathophysiology of PML.

Keyword

AIDS; Progressive multifocal leukoencephalopathy; Proton magnetic resonance spectroscopy; Diffusion-weighted imaging

MeSH Terms

Diagnosis
Diffusion*
Humans
Immunocompromised Host
Leukoencephalopathy, Progressive Multifocal*
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy*
Neurons
Protons*
Rare Diseases
Protons

Figure

• 

  Figure 1 ADC maps and DWI at the first and second examinations. (A) Axial DWI showed a high signal intensity at the left frontal and right parietal lesions. (B) Follow-up DWI performed 1 month after the first MRI showed extension of the previous lesion, with a high signal intensity on the medial border. ADC value was low to normal at the medial border of the lesion, whereas it was high in the center of the lesion.

• 

  Figure 2 Proton-MRS spectra acquired from white matter in newer (A) and older (B) PML lesions and in a control subject (C). Cho, lactate, and lipids were higher and NAA was lower in PML lesions than in normal white matter. Resonance values: NAA; 2.01 ppm, Cr; 3.04 ppm, Cho; 3.22 ppm, lactate; 1.33 ppm, and lipids; 0.90 ppm.

Reference

1. Wilkinson ID, Miller RF, Miszkiel KA, Paley MN, Hall-Craggs MA, Baldeweg T, et al. Cerebral proton magnetic resonance spectroscopy in asymptomatic HIV infection. AIDS. 1997. 11:289–295.

2. Henderson RD, Smith MG, Mowat P, Read SJ. Progressive multifocal leukoencephalopathy. Neurology. 2002. 58:1825.

3. Ohta K, Obara K, Sakauchi M, Obara K, Takane H, Yogo Y. Lesion extension detected by diffusion-weighted magnetic resonance imaging in progressive multifocal leukoencephalopathy. J Neurol. 2001. 248:809–811.

4. Mader I, Herrlinger U, Klose U, Schmidt F, Kuker W. Progressive multifocal leukoencephalopathy: analysis of lesion development with diffusion-weighted MRI. Neuroradiology. 2003. 45:717–721.

5. Chang L, Ernst T, Tornatore C, Aronow H, Melchor R, Walot I, et al. Metabolite abnormalities in progressive multifocal leukoencephalopathy by proton magnetic resonance spectroscopy. Neurology. 1997. 48:836–845.

6. Iranzo A, Moreno A, Pujol J, Marti-Fabregas J, Domingo P, Molet J, et al. Proton magnetic resonance spectroscopy pattern of progressive multifocal leukoencephalopathy in AIDS. J Neurol Neurosurg Psychiatry. 1999. 66:520–523.

7. Simone IL, Federico F, Tortorella C, Andreula CF, Zimatore GB, Giannini P, et al. Localised 1H-MR spectroscopy for metabolic characterisation of diffuse and focal brain lesions in patients infected with HIV. J Neurol Neurosurg Psychiatry. 1998. 64:516–523.

8. Bergui M, Bradac GB, Oguz KK, Boghi A, Geda C, Gatti G, et al. Progressive multifocal leukoencephalopathy: diffusion-weighted imaging and pathological correlations. Neuroradiology. 2004. 46:22–25.

9. Berger JR, Koralnik IJ. Progressive multifocal leukoencephalopathy and natalizumab - unforeseen consequences. N Engl J Med. 2005. 353:414–416.

10. Kleinschmidt-DeMasters BK, Tyler KL. Progressive multifocal leukoencephalopathy complicating treatment with natalizumab and interferon beta-1a for multiple sclerosis. N Engl J Med. 2005. 353:369–374.